Rediscovering Alcoholism, Addiction & Dependence

Transcription

1 Rediscovering Alcoholism, Addiction & Dependence Ray Daugherty, President PRI PRIME for Life/PRIME Solutions Copyright , Prevention Research Institute

2 Alcoholism/Addiction Are Dependence they the same? And Does it Matter?

3 Why does it matter? It matters if being research-based or evidence-based matters our words are our primary vehicle for communication and understanding. addiction? dependence? alcoholism

4 Why Does it Matter? Do researchers mean what counselors do when they use the word alcoholism? Did the DSM-IV Workgroup mean Dependence to be Alcoholism? Does your colleague down the hall use the words with the same meaning as you?

5 Why does it matter? These words carry beliefs and counselor addiction dependence? belief is a major factor in client improvement alcoholism our belief and our doubt is often rooted in our paradigms.

6 Paradigm Confusion?

7 Objectives Lessen communication barriers due to paradigm confusion. Separate the paradigms of Alcoholism, Addiction and Dependence Identify real world implications for serving clients better: DSM-5 and beyond.

8 Let s consider some Paradigm Questions Paradigm questions are those with more than one answer, each making total sense when viewed from one paradigm and no sense from another.

9 Paradigm Questions Are alcoholism/addiction diseases? Addiction is not a disease but rather a behavior that can be controlled, according to a Harvard psychologist who points to the fact that some addicts can voluntarily yquit using, to support his hypothesis. Gene M. Heyman author of the new book, Addiction: A Disorder of Choice, writes that the public has been deceived by addiction experts. Join Together Online, May 2009

10 Paradigm Questions What is the nature of alcoholism? "We're on the cusp of some major advances in how we conceptualize alcoholism. The focus now is on the large group of people who are not yet dependent. But they are at risk for developing dependence." Dr. Mark Willenbring, (formerly of NIAAA)

11 Paradigm Questions What are types of Alcoholism? Young Adult Subtype (31.5%) Young Antisocial Subtype (21%) Functional Subtype (19.5%) Intermediate Familial Subtype (19%) Chronic Severe Subtype (9%) Moss, Howard B., Chen, Chiung M., and Yi, Hsiao-Ye (2007). Subtypes of alcohol dependence in a nationally representative sample. Drug and Alcohol Dependence, 91, issues 2-3, Pages

12 Paradigm Questions Can people with alcoholism return to low-risk drinking? Seventy years ago, Bill Wilson -- the co-founder of Alcoholics Anonymous -- declared his powerlessness over alcohol (he) contended that, as an alcoholic, he had to "hit bottom" before changing his life and that t sobriety could only be achieved through complete abstention. For generations, Americans took these tenets to be true for everyone. Top addiction experts are no longer sure. LA Times, November 16, 2009

13 To Frame the Discussion Let s focus on the question of returning to low-risk drinking as a paradigm question.

14 Forty yyears of research.. Clearly, people with serious problems can return to low-risk drinking. Snapshots in time document this repeatedly. Longer term studies of those with the most severe problems are not so clear. It is clear we are dealing with a condition that lies on a continuum of severity.

15 Research Says... In 1953, Straus and Bacon published the first large study of college drinking behavior. Twenty seven years later, Fillmore (1974, 1975) followed up with the problem drinkers in Straus and Bacon s study. She found many of the heavy problem drinkers in college were drinking small quantities with no problems 27 years later.

16 Research Says... Cahalan and Room published Drinking in America in 1969 and then Problem Drinking Among American Men in First national studies of adult drinking Found that many alcohol problems go away over time

17 Research Says... Results of the RAND Report (Armor, Polich, & Stambul, 1976) and then Sobell & Sobell s study (1976) indicated that some alcoholics return to moderate drinking. More traditional views were supported when Pendery et al. (1982) found most of the Sobells success stories had relapsed. Ewing also initially found clients returning to drinking without problems, then his own research led to a retraction.

18 Research Says... Can they return to low-risk drinking? Helger, et. al. (1985) followed people treated for alcoholism and found: Less than 2% of people with alcoholism returned to stable moderate drinking for more than 1-2 years Another 4.6% drank occasionally

19 Research Says... Dawson s 1996 National Alcohol Epidemiological study on a general population found: Almost half of those ever qualifying for a DSM-IV dependence diagnosis later returned to drinking without problems Rates varied greatly with time elapsed, age, and treatment status The phenomenon occurred in each group, and for some, was sustained for at least two decades

20 Then in 2005 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) Dawson, D., Grant, B. F., Stinson, F. S., Chou, P. S., Huang, B. & Ruan, W. J. (2005). Recovery from DSM-IV alcohol dependence: United States, Addiction, 100,